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Pediatr Radiol. 2003 May;33(5):311-5. Epub 2003 Mar 6.

Biliary atresia: making the diagnosis by the gallbladder ghost triad.

Author information

1
Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore. annetan@kkh.com.sg

Abstract

OBJECTIVE:

To describe the gallbladder ghost triad and evaluate its usefulness in the sonographic diagnosis of extrahepatic biliary atresia (BA).

METHODS:

From October 1997 to February 2002, 217 fasted infants with cholestatic jaundice aged 2-12 weeks were examined sonographically. We defined the gallbladder ghost triad as gallbladder length <1.9 cm, lack of smooth/complete echogenic mucosal lining with an indistinct wall and irregular/lobular contour, and used it as a criteria for BA. Gallbladder wall thickness, triangular cord, diffuse periportal echogenicity and hepatic artery calibre were also recorded. Diagnosis of BA was confirmed surgically and histologically.

RESULTS:

Thirty of 31 babies with BA demonstrated the gallbladder ghost triad. No false-positives were recorded. The 31st BA baby showed a normal gallbladder at 6 weeks, but developed the ghost triad at 8 weeks. Gallbladder wall thickening was seen in 46/186 non-BA babies, but not in BA. Triangular cord was observed in 24/31 babies. Twenty-two of 186 non-BA babies and 5/31 BA babies showed diffuse periportal echogenicity. The hepatic artery appeared more prominent in BA. All 31 babies diagnosed sonographically as BA had surgery. Three non-BA babies had "negative" laparotomies showing hypoplastic bile ducts.

CONCLUSIONS:

The gallbladder ghost triad is a very accurate sign of BA. Indeterminate cases require close follow-up.

PMID:
12695863
DOI:
10.1007/s00247-003-0867-z
[Indexed for MEDLINE]
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